Home Health And Medicare: Everything You Need To Know About Your Coverage

Planning your home care when you use medicare insurance can be a little complicated. Your care is only covered under specific conditions, and some services may not qualify for coverage. If your doctor has recommended home care, it's important to understand how you can stay within medicare requirements as you look for a caregiver.

What Home Healthcare Services Qualify For Medicare Coverage?

The first step to ensuring your home care qualifies for coverage is getting a doctor's prescription. If you're looking for caregiving agencies without your doctor's go-ahead, you won't be able to use medicare to pay for your care. You also must be homebound to qualify for coverage. This doesn't necessarily mean you have to be bedridden, though. You just need to be able to show that you cannot leave your home without assistance or that leaving your home would put an undue amount of strain on your health.

Your doctor may help you look for an appropriate caregiver, but you should speak to a representative from each potential agency about using medicare. Only certain caregivers are covered, and if you agree to treatment from the wrong one, you could be on the hook for the cost of your care.

The scope of your care can also affect whether it qualifies for medicare coverage. Checking your vitals, helping you take your medicine, and ensuring you can safely get around your home are all services 100% covered by medicare. Other optional services like buying your groceries, cooking meals, cleaning your home, walking the dog, and providing round-the-clock care are not covered; though, you can pay out of pocket to add these services if you choose.

In some cases, you may encounter one exception to this all-or-nothing rule of coverage: medical equipment that must be rented for the duration of your care will only have 80% of its rental costs covered. If your care involves these expenses, you'll have to make plans with the caregiver for how you will cover the additional 20%.

Is There A Limit To How Long You Can Receive Care?

As long as your care is not so comprehensive as to fall under round-the-clock assistance, there is no limit to how long you can receive care in terms of days or months. There is a limit to how much medicare will pay for services, but this isn't something you'll have to deal with. Instead medicare will just cap how much the caregivers are allowed to charge you for qualifying services.

When your condition begins to stabilize, however, your doctor and caregiver will likely start talking with you about ending your care services. Medicare will only provide coverage for the services it takes to help you get back to your baseline of health after an accident, illness, or surgery. This can be seen as a limit to your coverage, since you will no longer be able to bill services to medicare once you have recovered.

The decision about whether your condition is stable will be up to your doctor, your caregiver or care agency, and your medicare representative. If you are deemed stable and lose your coverage, you will also be provided a chance to appeal the decision. Your medicare representative and doctor will walk you through the process if this happens.

Will Medicare Part C or Medigap Plans Reduce Your Expenses?

Yes. Recipients of medicare part C may be able to receive home health care when in stable condition and may be able to receive a wider range of coverage on offered services. Part C and Medigap both may also help with the cost of renting medical equipment, covering the additional 20% that typical medicare would not cover. For more specific information about what services will and won't be covered, you should talk to your plan provider before choosing a caregiver.

Navigating the medicare regulations for at home healthcare can be intimidating, but you'll have to do it if you want to be fully covered. Make sure you understand how much you'll pay out of pocket before you agree to any services. Hopefully if everything goes to plan, you can spend as little as possible of your own money and make a speedy recovery in the comfort of your home.